Adult Cognitive Behavior Therapy

Lynn McFarr, Ph.D., Director, Cognitive Behavioral/Dialectical Behavior Therapy Clinic

The clinical emphasis of the Adult CBT fellowship is the pragmatic application of Cognitive Behavior Therapies to multi-problem patients.  Fellows receive advanced training in Cognitive Behavior Therapy (CBT), Dialectical Behavior Therapy (DBT) for borderline personality disorder, as well as Cognitive Behavioral System of Psychotherapy (CBASP) for chronic depression and to a lesser extent Acceptance and Commitment Therapy (ACT).  Fellows lead groups and see individual patients utilizing the above modalities for a variety of disorders, including obsessive-compulsive disorder, bipolar disorder, panic, post-traumatic stress disorder, chronic depression and psychosis.  Fellows carry Dialectical Behavior Therapy individual patients, CBT/ACT patients and CBASP patients in individual psychotherapy.  Fellows also supervise the cognitive behavior therapy externs, and assist in the teaching of several CBT courses.  Fellows provide CBT training in the community as part of the professional development of the postdoc as well as part of the clinic’s aim to disseminate state of the art treatments to front line clinicians. Fellows serve one of several interdisciplinary outpatient teams where they consult to the team on issues related to psychology and CBT. The teams are comprised of psychiatrists, psychologists, social workers, psychiatry residents, psychiatric nurses, and other trainees.  At the request of the team, the fellow may field referrals for formal psychological testing for the team’s caseload.

The fellow is aided in the transition to professional by serving as the junior administrator of a CBT Clinic or Implementation Practice. In this capacity, the fellow learns how to track and triage referrals, assist in the coordination of the externs, clinicians, clerical and research staff. Fellows also participate in quality improvement, research, planning and execution of specialized training, and other academic and administrative endeavors.

Fellows also participate actively in research. The research is generally real world effectiveness outcomes of clinical interventions and trainings. We are particularly interested in cultural enhancements to evidence based treatments. Fellows, plan and execute an in-house research conference. Fellows also submit IRBs, prepare manuscripts and submit research for publication and presentation at national and international conferences.

Fellows spend 50% of their time at Harbor-UCLA in the CBT/DBT Clinic.

Through mutual agreement, the fellow spends the other 50% of their time on one additional Sub-Emphasis for the year. Only one fellow will be chosen per Sub-Emphasis.

Harbor CBT

In addition to the duties listed above, the fellow on this sub-emphasis is focused on the day-to-day running of a busy outpatient CBT/DBT clinic. Additional duties include:

  • CBT group assessment clinic
  • Caseload of CBT/DBT patients
  • DBT outpatient skills group
  • Oversee externs running inpatient ACT groups
  • Oversee externs conducting group and individual CBTs in the Psych ER
  • Administratively overseeing the CBT/DBT Clinic
    • Tracking, triaging and assigning referrals
    • Handle requests for treatment, training and other services from the Department of Mental Health and the community
  • Serving as psychology representative on the Outpatient Psychiatry Team

CBT Dissemination

In addition to the duties listed above, the fellow on this sub-emphasis is focused on the systems-level dissemination on Case Conceptualization Based Cognitive Behavior Therapy to the LA County Department of Mental Health Clinicians. Additional duties include:

  • Conduct multiple in-person four day trainings of CBT to front line clinicians
  • Lead 4 weekly consultation calls to clinicians in the roll out
  • Review and score CTRS and CRRSs for clinicians on roll out
  • Oversee all data and QA collection

Goals and Objectives

At the completion of the fellowship year fellows will be able to practice at an independent practitioner level in the areas of:

  • Interpersonal Skills
    • Ability to take respectful, compassionate and professional approach with all contacts (patients, staff, students etc) in professional setting
    • Competence in functioning as the psychologist member of an inter-disciplinary core team.
  • Psychological Assessment.
    • Accurate sophisticated diagnosis of multi-problemed patients
    • Assessing and utilizing patient outcomes to direct CBT practice
    • Formal, hypothesis driven psychological testing (Dissemination sub emphasis only)
    • Writing concise, tailored assessment reports (Dissemination subemphasis)
  • Research/Scholarly Activity/Program Evaluation
    • Plan and execute applied research
    • Oversee research assistants
    • Write IRBs
    • Prepare and submit manuscripts for presentation/publication
    • Presentation of findings at either: in-house, national and international conferences
  • Cognitive Behavior Therapies (CBT, DBT, CBASP and ACT)
    • Provision of comprehensive, case conceptualization approach to CBT, DBT, CBASP and ACT
    • Adherent, flexible practice of each model
  • Teaching/Training
    • Teach graduate students, psychiatry residents and front line clinicians CBTs across a number of modalities and settings
  • Consultation/Interdisciplinary Collaborations
    • Providing consultation to front line clinicians on CBTs
    • Provide consultation to DBT teams on practice and team implementation
  • Diversity
    • Accounting for the impact of diversity in the psychotherapy and assessment process
    • Particularly in the area of culturally competent practice of CBTs.
  • Ethics
    • Ethical practice of CBT, ethical research, consultation and supervision
  • Self Management
    • Knowledge of one’s scope of practice and professional limits
    • Practice of prompt and timely work habits
    • Self care
  • Leadership Skills
    • Effectively lead interdisciplinary teams
  • Supervisory Skills
    • Adherent practice of model consistent CBT(s) supervision
    • Treatment planning and intervention which takes into account diagnosis, personal differences attributes and resources, immediate social systems, and community resources.
    • Crisis Intervention in which there is a competent and complete assessment for suicidal/homicidal risk and the appropriate steps to protect patient and others.
    • Competence in functioning as the psychologist member of an inter-disciplinary core team.
    • Competence in administrating the day-to-day working of an outpatient CBT Clinic

Prerequisites

  • Prior experience in the assessment and treatment of persons with severe and persistent mental illness.
  • Previous significant experience conducting group and individual CBT and DBT.
  • Experience with ACT, and/or CBASP is preferable but not necessary.
  • History of scholarly activity and interest in applied research.

Required Clinical Experiences

  • Maintain a caseload of individual CBT/DBT/CBASP outpatients under the supervision of a licensed psychologist or board certified psychiatrist.
  • Participate in Dialectic Behavior Therapy Program (skills group co-leader, individual therapist, attend weekly consultation team, track attendance, referrals, supervise collection of data as necessary, supervise practicum students, provide after-hours skills coaching).
  • Attend weekly outpatient team rounds.  Responsibilities include serving as psychology representative to team.  Field referrals for CBT Clinic and psychological testing for the team.
  • Supervise externs (6 months each).
  • Cognitive Behavior Therapy Clinical Issues Seminar
  • Attend 3 day intensive training for DBT.
  • Attend 1 day Intensive CBASP Training.
  • Attend 1 day intensive ACT Training.
  • Teach weekly 9 month CBT course at Harbor-UCLA Medical Center.
  • Provide 3 Day intensive trainings in CBT to county clinicians
  • Provide weekly 1 hour case consultation over conference call for students in community CBT class.
  • Teach bimonthly CBT Group Supervision course.
  • Participate and run new and ongoing research.

Required Supervision

  • Meets weekly for 1 hour individual supervision with emphasis area supervisor
  • Meets weekly for 1 hour with sub-emphasis psychologist supervisor
  • Attend DBT Team meeting
  • Attend CBT Case Conference

Required Courses

  • Cognitive Behavior Therapy Seminar (the fellow assists in teaching the course) 1.5 hours/week
  • Three day DBT training (24 hours)
  • One day CBASP training (8 hours)
  • One day ACT training (8 hours)
  • Psychology Case Conference (1.5 hrs/week)
  • DBT Team Meeting (1.5 hrs/week)
  • CBT/DBT Research Meeting (1 hr/week)
  • Clinician Mindfulness (30 min/week)
  • Advances in Cognitive Therapy 1.5 hrs/ week. At least one three day training per year (24 hours)
  • Supervision of CBT Supervision Course 1hr/wk
  • Groups Skills Training Supervision (Fellow leads this course). .75/hrs bimonthly

Elective Courses/Clinical Experiences

  • Rotate for one month full-time as primary evaluator in the Psychiatry ER
  • Psychiatry Grand Rounds
  • Tavistock Group Relations Conference (4 day full-time experience)

Evaluation of Satisfactory Progress and Outcome

Must be rated “3” or higher on each domain on the Postdoctoral Fellow Evaluation Form.

In addition:

  • Research/Scholarly Activity/Program Evaluation
    • Successful IRB submission
    • Successful submission of manuscripts for presentation/publication
    • Presentation of findings at either: in-house, national and international conferences
  • CBTs :
    • CTRS score of 40 or higher on at least two tapes.
    • CRRS score of 20 or higher on at least one case conceptualization that competently takes into account diversity issues
  • Consultation/Interdisciplinary Collaborations
    • CTRS score of 40 or higher on at least two tapes of consultation
    • Observation of consultation to DBT teams on practice and team implementation
  • Diversity
    • Accounting for the impact of diversity in the psychotherapy and assessment process as noted on CRRS
    • Particularly in the area of culturally competent practice of CBTs (as measured on the CTRS for therapy, consultation and supervision.
  • Ethics
    • Observation of ethical decision making across supervision, consultation, therapy and research
  • Self Management
    • Knowledge of one’s scope of practice and professional limits
    • Practice of prompt and timely work habits
    • Self care
  • Leadership Skills
    • Effectively lead interdisciplinary teams
  • Supervisory Skills
    • Adherent practice of model consistent CBT(s) supervision
    • CTRS score of 40 or higher for supervision
  • Teaching
    • Teaching evaluations of “satisfactory” or higher
    • Observation of competence in functioning as the psychologist member of an inter-disciplinary core team.
    • Competence in administrating the day-to-day working of an outpatient CBT Clinic